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Am J Perinatol 2020; 37(14): 1411-1416
DOI: 10.1055/s-0040-1718403
Original Article

Obstetric Hemorrhage Risk Associated with Novel COVID-19 Diagnosis from a Single-Institution Cohort in the United States

Michelle J. Wang 
1   Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
,
Melissa Schapero
1   Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
,
Ronald Iverson
1   Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
,
Christina D. Yarrington
1   Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
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Abstract

Objective The study aimed to compare the quantitative blood loss (QBL) and hemorrhage-related outcomes of pregnant women with and without a coronavirus disease 2019 (COVID-19) diagnosis.

Study Design This retrospective cohort study of all live deliveries at Boston Medical Center between April 1, 2020 and July 22, 2020 compares the outcomes of pregnant women with a laboratory-confirmed COVID-19 positive diagnosis and pregnant women without COVID-19. The primary outcomes are QBL and obstetric hemorrhage. The secondary outcomes analyzed were a maternal composite outcome that consisted of obstetric hemorrhage, telemetry-level (intermediate care unit) or intensive care unit, transfusion, length of stay greater than 5 days, or intraamniotic infection, and individual components of the maternal composite outcome. Groups were compared using Student's t-test, Chi-squared tests, or Fisher's exact. Logistic regression was used to adjust for confounding variables.

Results Of 813 women who delivered a live infant between April 1 and July 22, 2020, 53 women were diagnosed with COVID-19 on admission to the hospital. Women with a COVID-19 diagnosis at their time of delivery were significantly more likely to identify as a race other than white (p = 0.01), to deliver preterm (p = 0.05), to be diagnosed with preeclampsia with severe features (p < 0.01), and to require general anesthesia (p < 0.01). Women diagnosed with COVID-19 did not have a significantly higher QBL (p = 0.64). COVID-19 positive pregnant patients had no increased adjusted odds of obstetric hemorrhage (adjusted odds ratio [aOR]: 0.41, 95% confidence interval [CI]: 0.17–1.04) and no increased adjusted odds of the maternal morbidity composite (aOR: 0.98, 95% CI: 0.50–1.93) when compared with those without a diagnosis of COVID-19.

Conclusion Pregnant women with COVID-19 diagnosis do not have increased risk for obstetric hemorrhage, increased QBL or risk of maternal morbidity compared with pregnant women without a COVID-19 diagnosis. Further research is needed to describe the impact of a COVID-19 diagnosis on maternal hematologic physiology and pregnancy outcomes.

Key Points

  • Information about blood loss associated with peripartum COVID-19 is limited.

  • COVID-19 diagnosis is not associated with increase in obstetric hemorrhage.

  • COVID-19 diagnosis is not associated with increase in blood loss.

Keywords

quantitative blood loss - obstetric hemorrhage - SARS-CoV-2 - Pregnancy

Note

This study is approved by Boston University Institutional Reference Board (reference number: 1311956).




Publication History

Received: 12 August 2020

Accepted: 07 September 2020

Article published online:
29 September 2020

© 2020. Thieme. All rights reserved.

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